Treat Everyone Like an Athlete

What I’ve seen in my profession over my lifespan starts with my dad. He was peppering me to decide what I wanted to do with the rest of my life at about grade 9, forcing me to think about it around that time. My mum was actually attending a physiotherapist for a meniscus tear, and as she laid there with the interferential machine on, one of the suction cups making her leg tremor as it stimulated the muscles, I watched the way the physio walked around consulting several people at a time, dressed in a polo shirt with a bit of a bent towards sports injuries. It looked like a cool job, and I was into sport and loved it a lot, so it seemed like a good career for me. So I chose physio.

This was back in the early to mid 90s, and physiotherapy clinics then seemed to be multiple beds of clients sitting there with either an interferential machine on them or the physio using an ultrasound machine on a targeted area. It seemed back in that day that the physio, or the sports physio, was the one to go to for managing your injuries. As sport started to become a bit more professional around this time, physiotherapists found their way into employment within sporting teams and clubs. This was the birth of the sports physio movement.

Fast forward a few years. I graduated in 1999, then gravitated more towards clinical practice and sports physio. I cut my teeth in what I’d call community rugby land, because my boss was looking after a Brisbane rugby club, so I got some exposure to the athletics community and the injuries that came with it. Not long after that I got exposure to the AFL system.

In the early 2000s I was lucky to work with and receive education from leading Brisbane physiotherapists like Peter Stanton and Victor Popov, who were physios at the Brisbane Lions when they’d just won a three-peat of AFL premierships. Their knowledge base was immense. They were implementing cutting-edge technologies, including cold rooms for the players at halftime and slushies to reduce core temperature as the players ingested the cold liquid. They would also IV fluid the players at half time to rehydrate them without causing bloating from excessive fluid consumption (now banned under anti-doping regulations). I also saw the introduction of the early stages of what became PRP and Actovegin injections into muscle tears to help augment the healing process. A lot of these progressive techniques seemed to come from outside the profession, so early on I learned that you need to look out into other industries and learn from other clinicians and doctors in order to provide a high-quality physiotherapy service.

Not long after that, I believe the year was 2007, I got my first opportunity in a head role at the Brisbane Lions in the AFL competition. The experience and the learning of what that job required were immense, and extremely challenging for me as a young physio. Very quickly you learned to be a member of the team, to have a strong rationale for any clinical decision you were going to make. Being in that environment also let me learn from strength and conditioning coaches, doctors, surgeons, skill coaches and development coaches, and then more outside my field again: recruitment processes and the importance of that process for the outcome of the team. Even a bit more obscure than that, I learned the importance of the home life of players, their welfare and their mental state, as something that could impact their performance, their injury and their next contract negotiation, which had a fairly solid influence on how things got managed within a team environment.

So in the early to middle part of my career I had a lot of learning and a lot of exposure to different types of injuries, as well as a lot of the other aspects of player management and welfare that were considered outside the scope of physiotherapy.

As I transitioned through this career of about 11 years, and then due to my own pressure of having a young family, sports physio life became too challenging to maintain a happy home life, especially when you were the full-time guy with a bit of support. So I moved into clinical practice, where I essentially used all those skills to provide a high-quality service to my clients. One of my mantras is that you treat everybody like an athlete. You just have to match their rehabilitation with their level, their capacities and their ability to comply with what that injury may require. Generally, a lot of people like being treated this way, because ultimately everybody wants to perform at their highest level and have no pain.

In clinical life it became apparent: why don’t we offer a lot of the services that the sports teams are providing? So we were the first in Brisbane to have the full suite of recovery services as part of a physio clinic. We had an ice bath or cold plunge, a hot bath, a sauna, the NormaTec boots, massage chairs, massage guns and red light therapy, and we serviced many individual athletes, and many teams came through our facility.

Then, with Freya and Kris, we decided to adopt the same model in Noosa. Kris is a physio I’ve worked with for over 20 years, and Freya is one of the other founders of kitt. We created a business there with a physiotherapy service, exercise physiology services, massage, cold plunge, hot bath, sauna, massage guns and NormaTec boots, as well as a functioning gym for rehabilitation and other fitness enthusiasts.

So now, more in the mid to latest stages of my career, I look back and consider what we were doing from a technology point of view. In one part we added the technology pieces, the ice bath and the sauna, but in the earlier stages of our career we were doing stick figures for exercise programs, showing and coaching those exercises, and the method of delivery was concurrent with the technology of the time. Nowadays, since the mid 2000s, there has been an explosion in software and technological advancement.

Additionally, with that, and with the advent of social media, physiotherapists are now competing with fitness influencers who have little in the way of medical training or scientific backing, who’ll point their arse at the camera, squat, and tell you that these five glute exercises are what will make you better. On top of that, the marketplace now has exercise physiologists, sports massage therapists, personal trainers, sports chiropractors, sports osteos and many other clinicians all vying for the space of medical rehab, performance enhancement, and even longevity with the more recent research.

I guess my position, as a physio who has come through a background of physiotherapy, which tends to sit more in the space of protect the injured tissue, promote healing of that tissue and recondition that tissue, is this: when you understand that a bigger part of that is maintaining capacity across the entire body, and that tissue tolerance is probably even more affected than the injury itself, you realise you have to have knowledge of all the areas outlined above to be a holistic and high-quality clinician. So generally, and perhaps with a little bit of bias, I’d say the sports physiotherapist is probably the best at this, but I’m very supportive of other allied health people in this space.

I think we need to fight for the space now, because anyone with a camera thinks they can give you some rehab exercises, and as I roll my eyes scrolling my own social media at times, that injury is only a small part of the continuum. As a human and an athlete navigating your sport, your life, your family life and your working life, the ability to develop holistic and comprehensive programs is actually really difficult to do in half-hour timeslots. And with people so ADHD, a short little “these five exercises will fix you” is fraught with the danger of not looking at the whole system.

So in order to try to get the best possible product to physios and allied health, you need to be utilising technology and expertise at the same time. Our product, kitt, is exactly that. It’s built on all of my experience and that of many other clinicians, used as the training material, and it automates and makes far more user-friendly the compliance part of our job. The note-taking, the formulation of reports, the letters to doctors: that’s the stuff that usually gets done at the end of the day, or forgotten, or done the next morning before work, and generally hangs like a dark cloud over all clinicians. Ultimately that becomes a load on them, and it actually makes it harder to keep following through and giving a great service to your clients. That’s why we’ve done what we’ve done.

We think it’s extremely helpful, we think it’s backed in scientific principles and evidence-based practice, and it comes with experience from a multifaceted, multidisciplinary model. Ultimately that’s where it needs to go. So my job now, I feel, is to try to get that message to all of the clinicians outlined above, to make sure that our general standard of care is as high as possible for everybody, so they can live better for longer, or play more for longer.